MsP as a Medic Student: Lesson 1

Well, I’ve been thinking a lot about a call I ran as a medic student way back when (Ok, it was like 2 and a half years ago) and I thought I would share it with you all. I think this call has made me into the medic I am today.

We were dispatched to a scene of an “altered mental status” patient about 4 minutes from our base, with about a 12 minute transport time to the nearest hospital. In my little medic student mind, I am riding in the back of the rig going over every scenario I can. We have no age on the patient, so I’m thinking diabetes, stroke, head injury, drugs, ETOH, tumors, a flying pink unicorn up his nose etc etc. I was young as was thinking through all of my horses and my zebras. As we roll up on scene, my preceptor Jay sighed and I raised my brows quizzically at him.

“Known drug corner, kiddo. Grab some narcan and the monitor.”

I wasn’t in the “2080′s” of our clinicals yet- which is where your preceptor cuts you loose with the EMT-B and says, “go save lives, kid. I’ll tell you if you’re killing them,” but I was still confident enough to take reigns on this case. I precepted in an area with a high violence and drug rate, which prepared me for my future at my current company which has an even HIGHER violence and drug rate.

So, I’m walking on scene along with PD and I don’t see a patient “outside on ground, not moving” like dispatch had radioed in. I’m looking around the scene, I notice we are about 3 blocks south of my best friend’s house, so I know the area pretty well. I was with about 3 huge male local police officers, and my crew for the day, 2 huge men. The police officers know the man whom the call was placed for, he was a known dealer and user. We see this blur tear around the corner, and the police yell, “That’s him!” It all happened so fast. He was running towards us, and everyone was backing off. I noticed a large laceration to his forearm and he was swinging the injury around wildly. He turned around and ran in the other direction.

We kind of jogged about 1 block north and I could see my best friend’s house from where we were. (Mind, in the South, our blocks are not as big as they are in cities.) For some reason, the safety of my friend rushed to mind. As he jogged closer and closer to her house, I started getting sicker and sicker. I knew that her young sister was home alone and that their house had been before broken into. It was right on the edge of the “bad part” of town, so it was just nice enough to be targets of things like this. Without thinking, I made my way closer to her house versus the patient. WHY I was in pursuit with the officers, I don’t quite know. But he was my patient and I wanted him secure and safe in the rig. Well, he sees my sudden move to her side of the street and runs at me. This man is about 6 foot 4 and must weight upwards to around 300 lbs. I am 5 foot 2 and I can hold my own, but I’m no house. He ran at me hard and fast. The adrenaline takes over and when I realize what I’ve done, I am shocked. I tackled him to the ground. With all of these big, huge men watching, I took him down.

My preceptor chuckled as we struggled to get him on the stretcher. He had taken PCP and had sliced his forearm with a butcher knife. He was handcuffed to the stretcher and was bending the bars that held him there. The officers all clapped as I helped lift him into the truck.

Now here is where I was schooled.

Only one of his arms was handcuffed. I needed to dress his wound and start a line on him. Jay took vitals and ran an EKG while Jake prepped the IV line for me. We had requested PD to stay and ride with us since it would only be me and the aging Jay in the back of the unit, but they were short staffed and said, “She tackled him outright. He gets out of hand again, she knows what to do.” We all laughed. Looking back now, I should have begged them to stay.

Jay was printing out the EKG, SVT in the 180′s, when it happened. As I was opening the catheter to the 16 gauge needle I had in my hands, this patient took it from me with his uncuffed hand and stabbed me several times before we could stop him.

That needle hadn’t touched his arm, thank God. That was all I could keep saying over and over again.

He managed to stab me 6 times, once in the AC. It wasn’t that deep but that one required pressure on the way to the hospital. Jay and I literally had to sit on this man to keep him restrained during transport. En route, he even bit through the left lead on his chest. I don’t know if you’d ever want to put those things in your mouth after all of the gunk they go through, but next time you do an EKG, try to bend that lead in half (but not really, your boss may get upset) and imagine biting through that tough wire! It was pure craziness!

We got to the hospital and this patient had no IV, had ripped off his dressing, the report was “vague” and the vitals weren’t too current. But they all looked at me differently that day. Because as I was leaving the curtain I was in getting bandaged up and taking the necessary shots, I went to his room and wished him good luck. I told him that I hoped he would feel better soon and that there were no hard feelings on my part, the drugs had made him do it. His answer was to spit at me, because now the cops had charged him with assault on top of drug charges and evasion.

I apologized to the ER doc for not having everything current on him, especially not trying to get his heart rate down in the field.

He smiled and said, “MsP, you did better than most veterans would do on that call. You stayed calm.”

But I looked at Jay and hung my head. I felt like I had failed. The very first thing that you learn as an EMT and a Medic is “scene safety.” I had none on that call. I felt safe with PD there, I had chased after a known drug dealer who could have been armed. I stepped out of my “scope” and forcefully taken down a patient. I lost control of my scene and became a patient, and I had let my patient damage very expensive equipment on a truck that wasn’t even mine. I heard Jay on the phone with my clinical coordinator and my stomach dropped. I was going to get a fail for this clinical and would have to repeat 2 more shifts to make up for this one… if I was lucky. Maybe I had stepped too far out of line and would be taken out of clinicals. I teared up as I drew closer.

“She’s ok now, she got the necessary shots and she’s bandaged and ready to go. But you shoulda seen her, Sal. She took down that guy so fast we didn’t realize what was happening! And the way she handled him right as we were leaving, I see a lot of potential in this kid. She’s got a lot of heart,” he said, looking up at me and winking. We walked back to the unit and I was being sent home for the rest of the shift with full credit hours for “grace under pressure.” As I closed the back door to the rig, I looked up at the hospital and smiled. I could make it.

By all means, readers… please don’t chase drug dealers, please be safe on scene, and if you aren’t sure that you and your partner can control the scene efficiently, get additional help. But also take from this that even when things go so wrong, you can still be a compassionate caregiver.